Are GLP-1s supercharging—or tanking your sex drive? Experts explain

What are GLP-1s and how do they work?

Medications like Wegovy and Ozempic are two of the most well-known prescriptions in a class of drugs called GLP-1 receptor agonists, which mimic the GLP-1 hormone that regulates blood sugar and appetite. Most people are aware of GLP-1s now for their popularity as a weight loss medication, but they were originally created to treat Type 2 diabetes.

“Glucagon-like peptide-1 is a hormone produced in our guts in response to food — especially sugar and fat — that signals, among many pathways, for our gut to slow down (gastric emptying) and promotes feeling full (satiety),” says Dr. Carl Streed Jr., an associate professor of Medicine at Boston University and research lead for the Center for Transgender Medicine and Surgery at Boston Medical Center. “Typically when folks say GLP-1s we're actually referring to GLP-1 receptor agonists, medications that act like GLP-1 and promote satiety.”

The end result is that GLP-1s slow gastric emptying, suppress appetite, and keep blood sugar levels even, which means that you’ll feel full faster, eat less, and have fewer blood sugar spikes and crashes.

How do GLP-1s impact your sex drive?

Every medication on the market has side effects, and while most of the conversations surrounding GLP-1s are about how it impacts the gut, with people reporting nausea and bloating, this class of medication can also change the way you experience sexual desire — for better or worse.

“Libido effects of these medications are due to a large number of factors,” explains Dr. Justin Lehmiller, a senior research fellow at the Kinsey Institute, who recently co-authored a study about dating on GLP-1s. “There are the direct effects of the drug on the body and brain, plus potential side effects.”

Almost as many people have said that their interest in sex shot up as those who complained about the drug hurting their sex drive. According to a study that Lehmiller led with the Kinsey Institute and DatingAdvice.com, 18% of participants said their sexual desire increased, while 16% said it decreased. The study also found that 16% had improved sexual function, versus 12% who said it worsened. Men are also twice as likely as women to say GLP-1s made them more sexually adventurous.

“There are also impacts from weight loss itself, as well as changes in both how you see yourself and how others see and interact with you,” Lehmiller says. “Not everyone will experience the same effects on libido because everyone’s GLP-1 journey is a little different.”

Why would a GLP-1 improve your libido?

There are a couple of different things at play for people who experience a spike in their sex drive while on a GLP-1. Part of it has to do with their improved physical health, and part of it is purely psychological.

GLP-1s have been heralded as a miracle drug, and for good reason. They help to control chronic conditions, treat metabolic disease, and quiet “food noise,” but they also exist within a society that puts an outsized value on being thin. This pressure can be especially intense for gay men who engage in toxic gym and image-obsessed circuit party culture.

So for some people, once they’ve lost weight, their self-esteem skyrockets, which can supercharge their sex drive or make them feel more comfortable engaging in the kind of sex they’ve been interested in all along. “When you feel lighter and more confident in your body, then your perception of yourself blossoms, and that’ll likely make its way into the bedroom,” says Dr. Evan Goldstein, the leading anal health expert in the United States who founded Future Method, a sexual wellness brand dedicated to revolutionizing anal sex prep.

Do they impact sexual function?

GLP-1s also increase testosterone, which can heighten the sex drives for people of all genders. The increased vascularity after losing weight can also improve sexual function, the ability to orgasm, and even erectile dysfunction (though some people have also reported ED issues and premature ejaculation while on GLP-1s), according to the Sexual Medicine Society of North America.

Improved erections mean that "tops are getting a boost," Streed says. "There are several studies that suggest erectile dysfunction improves while on GLP-1s, which means they may be more ready to top," he explains.

Goldstein also points to hormonal changes as leading to a bump in libido. “Losing fat does indeed impact hormones, especially the decrease of estrogen and the increase of testosterone in males. Higher ’T’ levels increase your sexual drive and erectile function," he says.

This is why transgender folks who are balancing GLP-1s with hormone replacement therapy need to be closely monitored by a doctor. The medications can change your hormones, and there haven’t been enough studies done to know how they will interact with HRT and impact your sex life.

Why would a GLP-1 decrease your libido?

GLP-1s may make food seem less appealing to you, which can aid in weight loss, but they can also tank your libido for the same reason.

“The GLP-1 receptors and the drug's mechanism of action is involved in brain motivations,” Goldstein says. “Many people clearly lose interest in food or alcohol or even social interactions, including their overall libido. And weight loss alters hormones that can affect your overall sexual drive.”

GLP-1s are praised by users for reducing “food noise” and their appetite, but along with fat loss, you also lose muscle mass if you aren’t getting adequate nutrition and exercise, all of which can mean you also lose interest in sex. “Some people on GLP-1s lose desire for sex because they aren’t getting adequate calories and nutrition,” Lehmiller warns. “If your body is in starvation mode, you’re not going to be in the mood for much of anything.”

Streed also says bottoms may also take the brunt of the medication’s main side effects: GI issues like nausea, diarrhea, and constipation. “The adverse GI effects of GLP-1s can reduce anyone's feeling ready to have sex; no one recommends being nauseated while having sex,” he says. “More specifically to anal sex, GLP-1s can affect someone's readiness/willingness to bottom.”

How do GLP-1s impact gay men’s ability to bottom?

Bottoming while taking a GLP-1 can be a double-edged sword. On the one hand, for some people, the slower gut transit time means “they poop less, it’s compact and leaves the rectum fully, which translates to being more prepared for bottoming,” which can allow “for more spontaneity when it comes to sex,” Goldstein says. But other people “just feel like shit” while taking the medication because of the bloating, constipation, and gas. “I see so many people with new onset anal tears (fissures) or worsening dilated veins (hemorrhoids). Bleeding, pain, swelling, and overall pelvic spasms mean bottoming is off the table,” Goldstein says.

The solution is to eat more fiber, drink more water, and manage side effects with a stool softener and Miralax. “Clearly, people need to think about timing sex when they feel their best,” he recommends. “Less heavy meals. Less fats and dairy. Less alcohol. Smaller portions. The goal is to have predictable bowel function that affords you confidence during sexual play, especially when bottoming.”

What can you do if GLP-1s are negatively affecting your sex drive?

If you end up not being the chosen one who gets a supercharged sex drive and your ED problems fixed, but instead find yourself losing interest in sex, or struggling to bottom comfortably, what should you do?

Start exercising to regain muscle mass you may be losing from the medication, make sure you are getting adequate nutrition from the small meals you are eating, and contact your doctor to report the side effects you are experiencing.

“Seek professional advice from the prescriber and/or a medical professional like a urologist or endocrinologist,” Goldstein advises. “Blood work should be done. Hormone levels should be monitored, tweaked, and/or supplemented accordingly. Lastly, the dosing of the overall GLP-1’s medication may need to be adjusted, making sure its effects are optimized.”

And don’t let anyone tell you that the sexual dysfunction you are experiencing isn’t a big deal. You deserve to have a great sex life, even while taking a GLP-1. “Sex is so important. I see this firsthand in my practice, Bespoke Surgical in NYC, all the time,” he says. “We get one sex life and in my world, one asshole. Let’s feel amazing. Let’s have the most optimal medical conditions and have the best sex of our lives. Why the fuck not! Literally.”

Sources cited:

Dr. Justin Lehmiller is a psychologist, author, and senior research fellow at the Kinsey Institute, who recently co-authored a study about dating on GLP-1s.

Dr. Carl Streed Jr. is an associate professor of Medicine at Boston University and research lead for the Center for Transgender Medicine and Surgery at Boston Medical Center.

Dr. Evan Goldstein is the leading anal health expert in the United States who founded Future Method, a sexual wellness brand dedicated to revolutionizing anal sex prep.